System and method for determining and reporting data codes for medical billing to a third party payer

Abstract

A method and system for defining and reporting accurate medical codes of a patient for medical billing to a third party payer. The system includes an input terminal for inputting patient data by a physician. The system also include a computing system which assists the physician in determining a correct standardized code for a medical procedure performed by the physician on the patient. The system also includes a means for determining the point value of the selected standardized code. The system also creates a report including the selected standardized code, total point value, and relevant patient data for the third party payer.

Description

[0001] 1. Technical Field of the Invention[0002] This invention relates to medical coding and, more particularly, to a system and method for defining and reporting accurate medical codes for medical billing to a third party payer.[0003] 2. Description of Related Art[0004] As is well known in the medical field, billing for insurance and Medicare and Medicaid can be both time consuming and complex. For example, Medicare requires that a code be assigned for each patient encounter, such as during the interaction between a physician and patient and is also used in determining corresponding diagnostic codes defining the patient's medical problem. A third party payer is an organization, carrier or intermediary that supplies insurance (including Medicare) or payment to individuals for medical care.[0005] The American Medical Association in conjunction with the Health Care Financing Administration (HCFA) has developed a system of codes for the purpose of describing physician work for medical...

AI Technical Summary

Benefits of technology

[0016] In one aspect, the present invention is a system for defining and reporting accurate medical codes of a patient for medical billing to a third party payer. The system includes an input terminal for receiving data describing a medical procedure of the patient and a computing system communicating with the input terminal. The computing system includes a code correlator for assisting a physician in selecting a specific code from a plurality of standardized codes. The specific code accurately describes the medical procedure performed by the physician. In addition, the computing system includes means for calculating the total points associated with said selected code and a report generator for compiling the inputted data, the selected codes, and calculated points into a report for the third party payer.

[0017] In another aspect, the present invention is a system for defining and reporting accurate medical codes of a patient for medical billing to a third party payer. The system includes a device for receiving data describing a medical procedure of the patient and a computing system communicating with device for receiving data. The computing system assists a physician in selecting a specific code from a plurality of standardized codes. The specific code accurately describes the medical procedure performed by the physician. The computing system also calculates the total points associated with the selected code and a report generator for compiling the data, selected code, and calculated points into a report for the third party payer.

[0018] In still another aspect, the present invention is a system for defining and reporting accurate medical codes of a patient for medical billing to a third party payer. The system includes an input terminal for receiving data describing a medical procedure of the patient and a computing system communicating with the input terminal. The computing system includes a code correlator for assisting an anesthesiologist assisting in the medical procedure in selecting a specific code from a plurality of standardized Current Procedural Terminology (CPT) surgical codes. The specific code accurately describing the medical procedure performed on the patient. In addition, the computing system associates a CPT anesthesia code with the specific CPT surgical code and calculates the total points associated with the selected code. A report generator compiles the data, selected codes, and calculated points into a report for the third party payer.

Problems solved by technology

As is well known in the medical field, billing for insurance and Medicare and Medicaid can be both time consuming and complex.

However, these codes can be very complex.

In the situation where a surgical procedure involves multiple CPT codes for the same operation, the coding can become particularly complex because certain add-on modifiers are attached.

In the situation where multiple CPT surgical codes are necessary, errors are more likely to occur.

In addition, coding is frequently accomplished by office personnel who are not intimately familiar with the procedure being perform, thus resulting in more errors in the coding process.

Although Dorne discloses a method of correlating medical procedures with CPT codes, Dome does not teach or suggest generating timing points, speciality points, or associating the surgical procedures with ICD9 codes.

Dorne suffers from the disadvantage of merely cross coding medical procedures with CPT codes, without including additional billing factors.

In addition, Dorne does not teach or suggest correlating the CPT surgical codes with associated CPT anesthesia codes.

Also, Dorne only addresses correlating radiological procedures and does not teach or suggest utilizing the correlation for other fields, such as surgery or anesthesia.

Although Milstein discloses a method for calculating a CPT code and ICD9 codes associated with a particular medical procedure, Milstein does not teach or suggest a method providing timing points and speciality points to generate a billing report for a third party payer.

However, Ryan does not include calculating time points or other various specialty points used in computing billing reports for insurance companies.

The system categorizes non-principal-diagnostic claim items into the PTEs on the basis of temporal, physiological or clinical relations between the claims items and the PTEs However, Cave does not teach or suggest calculating time points or the specialty points used in computing billing reports for insurance companies.

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